Clinical Establishment Act Kerala: A Historic Initiative — B Ekbal

The Kerala Clinical Establishments (Registration and Regulation) Act 2017 is being implemented with effect from Jan 2019. The rules pertaining to the Act have already been framed. In the first phase, establishments under modern medicine including hospitals, clinics and laboratories will come under its purview.

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The law will be implemented in other medical systems in due course. The objective of the Act is to bring about uniformity in the services provided by government and private establishments and to ensure minimum standards in the services rendered by all health institutions and laboratories.

Kerala is one of the most medically dense societies. There are large number of hospitals and clinical establishments run by the government ,private establishments, co-operatives and ESIs. More than 70% of them is under the private sector. There is no system in place to monitor and regulate them. Reports of undue exploitation in regard to fees levied, neglect of providing treatment in time or denial of appropriate treatment are reported every day. Most of the laboratories function without any quality check. Medical expenses are soaring up. Kerala tops in per-capita medical expenses in the country. There are a good number of unqualified /under qualified/fake doctors who offer unscientific treatments to gullible patients.

There are provisions in the Act to check such anti social practices. The Act, which aims at ensuring quality and transparency in the functioning of medical establishments by bringing them under social control, is indeed a historic legislation.

Councils will be set up under the new law at the district and state levels for the registration and regulation of medical establishments. District councils will be authorized to register medical service providers, to renew such registration and to cancel registration in case violation of the rules. Unregistered establishments will not be allowed to function. Each establishment will be required to display details of services available, fees for such services and the qualification and experience of doctors and paramedical staff employed there. There will be a dedicated team to go into the complaints regarding medical service. The punishment for defective service would include withdrawal of registration of the institution concerned and levying fine.
An important provision in the Act relates to the regulations related to services available, fees and medical records in hospitals. Each clinical establishment would be required to display prominently details of the services available and fees levied for such services item wise and package wise, both in Malayalam and English. No establishment can charge fees higher than the displayed rate. Institutions will be required to keep under their custody details of the diagnosis of the disease, treatment given, and medical status of the patient at the time of discharge and advice rendered for further medical care. Such information should be made available to the patients or their relatives. It is mandatory for all establishments to administer life saving treatment and make arrangements for safe shifting of the patient to other hospitals, if necessary. The Council will notify the life saving services to be rendered by each category of medical establishment.
The Act has laid down the norms for the registration of medical establishments. All institutions should compulsorily have the minimum facilities notified by the Government .Medical and paramedical staff should have minimum notified qualifications. Temporary registration will be given to existing institutions as and when the Act comes into operation. They will be required to apply for permanent registration within two years after setting out all facilities as set out in the Act. Registration alone is required for establishments providing only consultancy services by doctors in their approved areas. The Council will notify a panel of experts for making periodic appraisal of different institutions. Each registered institution will be required to undergo appraisal at least once in two years to ensure maintenance of standards.

Private institutions are only required to display their fees by the Act. This is one of the limitations of the Act. The Council should be authorized to fix the fees for the treatment of different ailments. The Act should be strengthened by adding the provision that registered institutions should compulsorily follow treatment protocols and guidelines. For this, treatment protocols have to be evolved at the state level with the help of experts in the field. Government should also consider lesser stringent rules with regards to medium and small scale hospitals. Already with the advent of super specialty corporate hospitals and self financing medical colleges large number of small and medium hospitals are getting closed down.
It is necessary to acknowledge that the minimum facilities enlisted for all hospitals are equally applicable for government hospitals as well. There could be moral and legal impediments for regulating private establishments without ensuring minimum facilities in government hospitals. Government hospitals should become models, setting standards for other institutions. The initiative taken by the Government to improve the quality of Government hospitals through Aardhram Mission should receive greater momentum in view of the implementation of the Act.

(Dr. B.Ekbal is a Member, Kerala State Planning Board. He is a well- known people’s health activist from Kerala.)